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KMID : 1103720080580030229
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Journal of the Korean Society of Radiology
2008 Volume.58 No. 3 p.229 ~ p.236
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Percutaneous Lithotripsy for Removing Difficult Bile Duct Stones Using Endoscopy
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Kim Si-Hyung
Kim Young-Hwan
Sohn Chul-Ho
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Abstract
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Purpose: To describe efficacy of percutaneous lithotripsy for removing difficult bile duct stones using endoscopy.
Materials and Methods: A total of 88 patients with difficulties for the removal of bile duct stones using endoscopy (an impacted stone, stone size >15 mm, intrahepatic duct (IHD) stone, stone size to bile duct diameter ratio >1.0), were enrolled in this study. A 12 Fr sheath was inserted through the percutaneous transhepatic biliary drainage (PTBD) tract, and then nitrol stone baskets and a 0.035" snare wire were used to capture, fragment and remove the stones. The technical and clinical success rates were analyzed, together with an analysis of any complications.
Results: The overall technical success rate of stone removal was achieved in 79 of 88 patients (89.8%). In five of nine patients with failed stone removal, small residual IHD stones were noted on a cholangiogram. Even if stone removal failed in these cases, cholangitic symptoms were improved and the drainage catheter was successfully removed. Therefore, clinical success was achieved in 84 of 88 patients (95.5%). There were no significant procedure-related complications, except for sepsis in one case.
Conclusion: Billiary stone removal using the stone basket and guide-wire snare technique through the PTBD tract is a safe and effective procedure that can be used as a primary method in patients with difficulties for the removal of bile duct stones using endoscopy.
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KEYWORD
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Bile duct, calculi, Cholelithiasis, gallstone, Percutaneous lithotripsy
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